Apple, Amazon, and Uber are moving in on health care. Will it help?
Big tech is making its opening moves into the health care scene, but its focus on tech-savvy millennials may miss the mark.
- Companies like Apple, Amazon, and Google have been busy investing in health care companies, developing new apps, and hiring health professionals for new business ventures.
- Their current focus appears to be on tech-savvy millennials, but the bulk of health care expenditures goes to the elderly.
- Big tech should look to integrating its most promising health care devise, the smartphone, more thoroughly into health care.
Health care spending in the United States reached $3.5 trillion in 2017, roughly 18 percent of the nation's GDP. With so much to gain, big tech companies like Apple, Amazon, and Uber are making incipient moves into the space. Such moves from large economic players will alter traditional models of health care, no doubt in ways we can't fully envision.
But will it help? Potentially. In recent years, big tech has gathered the resources and creative minds to change the way we approach many aspects of our lives, even in conservative fields like health care. But to create lasting change, big tech will need to collaborate with traditional health care players to ensure all patients, not just the tech savvy, benefit.
Big tech's opening moves
Last year, Amazon purchased online pharmacy service PillPack for a cool $800 million. This has Angela Chen at The Verge wondering if we'll see PillPack integrated into Amazon's other services, allowing Prime members to order medication through the company's website. Such a prediction makes sense, but it's some ways off. Amazon just recently announced that Nader Kabbani, an Amazon veteran, would lead the pharmacy initiative.
Other tech giants have been making their opening moves, too.
Apple added a Health Records section to its iPhone, allowing users to view their medical records from participating health systems, and the FDA recently cleared an electrocardiogram accessory for the Apple Watch. Uber hired health consultant Aaron Crowell to head its health business venture to offer medical transport. And Microsoft has introduced a Healthcare Bot to provide virtual health chatbots to assist medical personnel.
Alphabet, Google's parent company, has made several health-centric efforts. These include investing in companies like 23andMe and Oscar health, collaborating with Fitbit to create patient-generated electronic health records, and experimenting with its AI platform Deepmind to improve health services and records.
Eyes on the patient, not the prize
What does telemedicine look like? Dr. Maurice Cates, Orthopedic Surgeon, conducts a live Orthopedic consultation remotely by video with a patient.
(Photo by Brooks Kraft LLC/Corbis via Getty Images)
As is evident, big tech's opening moves are less about disruption and more about positioning. Although we aren't seeing grand overhauls yet, we can predict where these companies plan to make their entry point. And the focus appears to be on their traditional base: tech-savvy, middle-class millennials.
That's a potential problem as Michael Dowling, CEO of Northwell Health, told Big Think:
"I welcome all of these players. Because the more players that you get coming in with a different perspective, the better we can get. But it's important for people to understand that most of these players are focusing in on the easy parts of health care. They're focusing in on non-hospital business. They're focusing in on people that are not that sick primarily. And they're dealing with the consumer who's 30 years old, 40 years old, 25 years old."
But the bulk of health care expenditures, Dowling notes, go to the elderly, specifically people in the last year to year-and-a-half of their lives. And because people are living longer, into their 80s and 90s, they'll spend more years drawing upon health care.
Devising apps for digital watches that generate electronic health records is amazing. But how many people do you know own a Fitbit or Apple Watch? How many elderly people take an Uber to the hospital, and how many Ubers are wheelchair accessible? The market for such devices remains niche, if growing, even among millennials.
Another consideration: Would Medicare cover such costs?
Even when tech is designed for the elderly or ill, it rarely considers their needs and partialities. In another Verge article, Chen surveyed the growing category of "aging tech" to discover airbag belts, smart shoes, and smart lamps, all designed to assist in the case of a fall.
As Chen notes: "So many of these devices seem to rely on the ability of caregivers to coerce their elderly relative or patient into using the solution. But if someone doesn't want to wear your shoe or your belt or your watch, it's hard to make them."
Despite these hurdles, big tech can still be a benefactor for health care, and its most serviceable offering is already here. The smartphone.
Unlike other devices trying to break in, the smartphone has already been widely adopted. Seventy-seven percent of Americans own smartphones, and 46 percent of Americans over 65 own one. Comparatively, only 18 percent of Americans own a fitness tracker and 13 percent a smartwatch.
The result is a health care device that requires little training for any demographic. Americans already use their smartphones for finances, travel, communications, reservations, photography, and a host of other daily activities. Adding health care to the mix would be a small ask, even for the elderly.
In his book Health Care Reboot, Dowling discusses a Northwell initiative that had patients televisit with their nurse through tablets and smartphones. The initiative hoped to better serve patients at home while limiting unnecessary travel and hospital visits. Initially, there was concern that older patients would have trouble adapting, but even patients in their 80s found the connection intuitive and helpful.
"The use of technologies such as smartphones, tablets, and laptops signals the beginnings of the age of the consumer in health care," writes Dowling. "In a general sense, as patient, a person is subservient to the provider. As consumer, the person is more empowered with greater access to information and an ability to behave as consumers do in other fields."
Like big tech, health care revolves around data — a patient's family history, their medical records, their current prescriptions, and the ever-evolving medical literature. The easier and faster it is to collect and coordinate this data between patient and provider, the better health care can become.
Smartphone architecture is already designed to collect and deliver data in a user-friendly manner. By pointing it in the direction of health care, big tech can help expand its definition beyond hospital visits to make the patient an active participant.
Why health care should start long before you reach the hospital
Medicago is growing a SARS-CoV-2 vaccine candidate in a relative of the tobacco plant right now.
- Canadian biotech company Medicago is growing a vaccine candidate in Nicotiana benthamiana.
- An Australian relative to tobacco, plant-based vaccines could be cheaper and more reliable than current methods.
- Medicago just completed phase 3 clinical trials of an influenza vaccine, which could be a game-changer for vaccine production.
Photo: alphaspirit / Adobe Stock<p>Clark <a href="https://www.medicago.com/en/newsroom/medicago-begins-phase-i-clinical-trials-for-its-covid-19-vaccine-candidate/" target="_blank">says</a> it's important to attack the novel coronavirus from all sides.</p><p style="margin-left: 20px;">"Creating a sufficient supply of COVID-19 vaccines within the next year is a challenge which will require multiple approaches, with different technologies. Our proven plant-based technology is capable of contributing to the collective solution to this public health emergency."</p><p>Unlike many common vaccines, VLP vaccines contain no genetic material. You won't get infected by it, which is always a risk in live vaccines. </p><p>This SARS-CoV-2 vaccine is not the only project on Medicago's hands. The company <a href="https://clinicaltrials.gov/ct2/show/NCT03301051" target="_blank">just completed</a> phase 3 clinical trials on an influenza. While no plant-based vaccine has been approved for use, the company hopes to replace the more cumbersome and expensive egg-based model, or at least offset some of the costs of that model. The plant model could help researchers adapt more quickly to the ever-changing influenza strains each season. </p><p>Plants offer a wonderful alternative to the current vaccination model. Besides price, VLP vaccines scale much easier and faster. If the SARS-CoV-2 vaccine works, Medicago <a href="https://www.medicago.com/en/newsroom/medicago-begins-phase-i-clinical-trials-for-its-covid-19-vaccine-candidate/" target="_blank" rel="noopener noreferrer">believes</a> they can produce a billion doses a year, by far the most ambitious yield to date. At a time when speed, cost, and reliability are all essential factors in vaccine development, we should put tobacco to better use: healing instead of harming. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
New cancer-scanning technology reveals a previously unknown detail of human anatomy.
- Scientists using new scanning technology and hunting for prostate tumors get a surprise.
- Behind the nasopharynx is a set of salivary glands that no one knew about.
- Finding the glands may allow for more complication-free radiation therapies.
PSMA PET/CT technology<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="676e611b970c9b516cace0870447b325"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/RHAyoQF09X4?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>PSMA PET/CT is a new combination of <a href="https://www.mayoclinic.org/tests-procedures/pet-scan/about/pac-20385078" target="_blank">PET scans</a> and <a href="https://www.mayoclinic.org/tests-procedures/ct-scan/about/pac-20393675" target="_blank">CT scans</a> that is believed to offer a more reliable means of locating prostate cancer metastasis. A <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis" target="_blank" rel="noopener noreferrer">study</a> published last spring suggests it may be the most accurate way to diagnose prostate cancer metastasis than any method previously available.</p><p>Prior to PSMA PET/CT, the primary way to look for metastatic prostate cancer was to image the body using x-ray-based CT scans and to perform bone scans, since bone is where prostate cancer often spreads. CT scans, however, often miss small tumors, and bone scans can generate false positives as a result of other damage or abnormalities that have nothing to do with prostate cancer.</p><p>PSMA PET/CT scans track the travels of an intravenously administered radioactive glucose tracer throughout the body. For hunting down prostate cancer, this tracer contains a molecule that binds to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472940/" target="_blank">PSMA</a> protein that's present in large amounts in prostate tumors. The molecule is linked to a radioisotope, <a href="https://netrf.org/2018/11/13/gallium-68-scan-for-neuroendocrine-tumors/" target="_blank" rel="noopener noreferrer">gallium-68</a> (Ga-68).</p><p>In last spring's research, PSAM PET/CT was shown to be 27 percent more accurate than previous methods at finding metastases (92 percent accuracy as opposed to 65 percent). In addition, it was found to be much less likely to produce false positives, and it was particularly good at detecting tumors far removed from the prostate.</p>
A good kind of avoidance behavior<p>"Radiation therapy can damage the salivary glands," says Vogel, "which may lead to complications. Patients may have trouble eating, swallowing, or speaking, which can be a real burden."</p><p>The researchers looked back through the cases of 723 patients who had undergone radiation treatment, interested in seeing if inadvertent radiation of the tubarial glands was associated with the complications experienced by the patients. It turned out that this <em>was</em> the case: In cases where more radiation had been delivered to this area, patients did indeed report more in the way of complications of the type one would expect when salivary glands are radiated.</p><p>Now that we know the tubarial salivary glands exist, therapists can stay out of their way. Vogel says, "For most patients, it should technically be possible to avoid delivering radiation to this newly discovered location of the salivary gland system in the same way we try to spare known glands."</p><p>He's hopeful that that things may be about to get at least a bit better for cancer patients: "Our next step is to find out how we can best spare these new glands and in which patients. If we can do this, patients may experience less side effects which will benefit their overall quality of life after treatment."</p>
A new survey found that 27 percent of millennials are saving more money due to the pandemic, but most can't stay within their budgets.
Taking control of bad luck<p>According to <a href="https://themanifest.com/accounting/budgeting-money-tips-for-millennials" target="_blank">a recent survey by The Manifest</a>, a business news website, millennials agree with Cramer. The study found that, of millennials surveyed, their largest expenses were housing (66 percent), educational expenses (9 percent), and health insurance (6 percent). In light of the COVID-19 pandemic, millennials are using the remaining 19 percent of their paychecks to budget and increase their savings.</p><p>About a third of millennials said they are saving more money in response to the pandemic and creating new budgets for themselves. In fact, of all generations surveyed, millennials felt the most comfortable creating personal budgets. They were also willing to think critically and adjust budgets to match financial changes, both signs that this highly-educated generation is willing to learn and adapt.</p><p>Millennials still have a rough road ahead, though. According to the survey, about half of millennials make less than $50,000 a year. That puts them into the upper-lower or lower-middle <a href="https://www.pewresearch.org/fact-tank/2020/07/23/are-you-in-the-american-middle-class/#:~:text=In%202018%2C%20the%20national%20middle,(incomes%20in%202018%20dollars)." target="_blank">income class</a>, depending on where in the country they live. That matches <a href="https://www.bls.gov/opub/mlr/2019/article/time-use-of-millennials-and-nonmillennials.htm#:~:text=Among%20full%2Dtime%20wage%20and,with%2031%20percent%20of%20nonmillennials." target="_blank" rel="noopener noreferrer">BLS data</a>, which shows millennials earning less than older non-millennials. <a href="https://www.bls.gov/opub/mlr/2019/beyond-bls/the-kids-are-alright-millennials-and-the-economy.htm" target="_blank" rel="noopener noreferrer">The BLS also notes</a> that while millennials have less debt than GenXers, most of that is student loan debt rather than mortgages.</p><p>And despite their budgetary plans, only 11 percent of millennials surveyed were able to stay within budget, while uncertainty still looms in the future job market.<em></em></p><p>With all this said, there are caveats to The Manifest survey. It hosted a relatively small sample size, only surveying 502 Americans. Of those, millennials made up 22 percent of respondents. They weren't even the largest cohort in the study. That was the baby boomers at 32 percent. </p><p>This makes the survey more suggestive than indicative. But the suggestion is that millennials, to borrow a phrase from writer Vicki Robin, are ready to reinterpret their relationship with finances.</p>
A push for financial freedom<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="a463513bfbe5a2b7d5bcc59f8be265a7"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/J-B-b393epk?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>While budgeting and financial savvy have always been important, the millennial generation will need to be far more critical of their relationship with the economy. What <a href="https://www.youtube.com/watch?v=T_tDthUWsVM" target="_blank" rel="noopener noreferrer">Robin calls the old roadmap</a>—the idea that "growth is good, more is better, game over"—is unlikely to support millennials as it did past generations. They'll need a new roadmap, charting both a new macro (the relationship between our economic and ecological footprints, for example) and micro (our individual relationships with money).</p><p>Because the macro is a whole other article, we'll stick with the micro here:</p><p><strong>1) Track and cut your spending</strong></p><p>The first step to financial freedom is to track your spending and cut unnecessary purchases. For Robin, these are often the things, services, and subscriptions that we buy out of habit, but we no longer consider whether they add value to our lives.</p><p>A pernicious modern example is the subscription economy. We subscribe to services for food, clothes, television, exercise, self-help, video games, bric-a-brac, computer programs, and on and on. These services quickly fade into the financial background as just another bill we pay. </p><p>But if we watch Netflix nine times out of ten, why pay for Hulu and Disney+ and HBO Max and CBS All access? Instead, every month or so, we should scrutinize our subscriptions to ask whether they still add value to our lives. If they don't, unsubscribe.</p><p><strong>2) Kill your debt</strong></p><p>Debt doesn't just take away money we could save elsewhere; it's also a self-replicating devourer of wealth. Your debt interest rates are almost certainly higher than your investment returns, especially on credit cards. Because of this, no matter your saving rituals, you're likely bleeding wealth the longer you remain in debt.</p><p>Instead, focus on removing debt from your life. Again, credit card debt especially. The good news is that most companies have hardship programs to help debtors. You can call them to see if they can lower your interest rates or provide other helpful services.</p><p>"Financial accommodations are generally readily available right now," Amy Thomann, the head of consumer credit education at TransUnion, <a href="https://www.nytimes.com/2020/08/29/at-home/manage-finances-save-money-millennials-coronavirus.html" target="_blank" rel="noopener noreferrer">told the New York Times</a><u>.</u> "Lenders, just like consumers, understand the hardships that are going on in the economy."</p><p><strong>3) Have an emergency fund</strong></p><p>Of course, you'll need some savings when the unexpected happens. Say—I don't know—a worldwide pandemic? Experts like Robin and Thomann recommend people have three to six months' worth of expenses on reserve. These should be in liquid assets so you can access them easily and quickly.</p><p>Of course, that's not always feasible, but you should save what you can. </p><p><strong>4) Find social outlets that don't cost</strong></p><p>The economic shutdown has offered one financial boon: It has revealed ways we can enjoy each other's company with overspending. We can host movies remotely with our friends. Play video games online. Enjoy physical-distance strolls through the park. And a host of other creative connections. After the pandemic, the occasional bar hop or Friday dinner out can still be a guilty pleasure. But unlike sitcom characters, we shouldn't be spending our social lives on the set of our favorite coffee shops or local watering holes.</p><p><strong>5) Reconsider your relationship with money</strong></p><p>Robin pushes her readers to be financially free. That is, to understand that there's an economy, people have a relationship with it, but it shouldn't become an obsession that runs their lives. As <a href="https://www.youtube.com/watch?v=xDaBjc4QyWU" target="_blank" rel="noopener noreferrer">she told <em>Big Think</em></a>: "It's like there are so many presumptions that drive us into wage [slavery], and it doesn't matter whether you are at the low end or the high end. If you are engaged in that sort of anxious process of 'more, more, more,' you are not free."</p><p>The millennial generation has certainly been dealt a bum hand, but it's perhaps defeatist, and more than a little premature, to label them the unluckiest generation. Perhaps after being led astray by the old roadmap, they will be the generation to reconsider their relationship with money—not as an end itself but a means to a healthier and more beneficial life. </p>
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